Examining renal patients' death trajectories without dialysis

Noble, H., Meyer, J., Bridges, J., Kelly, D. and Johnson, B. (2010) Examining renal patients' death trajectories without dialysis. End of Life Journal, 4 (2), 26-34.

Abstract

Background: minimal work has been carried out into dying trajectories of people with stage-5 (end-stage) chronic kidney disease (CKD). Consequently, little is known about such patients and how they and their families/loved ones cope with the dying phase of the disease.

Aim: this article reports on part of a larger, qualitative study exploring the experiences and trajectory towards death of people with stage-5 CKD who decided not to undergo dialysis. It provides case studies to illustrate the encountered death trajectories.

Methods: interview data were gathered during naturally occurring consultations with patients with stage-5 CKD and/or carers who were seen at a nurse-led, renal supportive care service. All patients referred to the service were asked to participate. Thirty patients and 17 carers were recruited. Patients were seen at approximately 3-month intervals until they died or the study finished. Carers took part in the consultation when present. Eighty-two consultations were included in the wider study.

Results: although the expectation was that patients would die from renal failure following a gradual decline in functional status, this was not always the case. The study identified three trajectories: those who died a typical uraemic death, those who followed another death trajectory, e.g. heart failure, and those where the cause of death was unclear.

Conclusions: the management of patients dying from stage-5 CKD and for whom the time and manner of death is unknown can be problematic for healthcare professionals.

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Contributors

Author: J. Bridges

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